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Delirium is an acute neuropsychiatric syndrome with currently no effective treatment. The acute encephalopathy underlying delirium is characterized by diffuse oscillatory slowing on electroencephalography (EEG). Based on its capacity to modulate oscillatory activity, 10 Hz transcranial alternating current stimulation (tACS) is a potential hypothesis-driven intervention for delirium. Before investigating potential neurophysiological or clinical effects, it is necessary to establish whether tACS is feasible and safe in delirious patients. This pilot study investigated the feasibility and safety of tACS in 30 hospitalized patients aged ≥50 years with delirium. Participants were randomized double-blind to receive either daily 10 Hz frontal-occipital tACS or sham stimulation for up to 14 days. The first-session completion rate was 94% (active) and 92% (sham). Participants had a median of 3 eligible treatment days (interquartile range [IQR]:2-4). The active group completed a median of 2 tACS sessions (IQR:2-3) and the sham group a median of 3 (IQR:2-4), corresponding to treatment adherence rates of 69% (95% confidence interval [CI]:57-79) and 73% (95% CI:59-83), respectively. The intervention was well-tolerated with no stimulation-related serious adverse events (AEs). AE frequency did not differ between active (35%) and sham (31%) groups. Side effects were mild, transient cutaneous sensations. In conclusion, short-course exposure to 10 Hz tACS can be safely initiated in hospitalized older adults with delirium, with a high first-session completion rate while delivery of repeated daily sessions remained challenging. These findings support further investigation of tACS in delirium, including studies specifically designed to evaluate neurophysiological and clinical effects. Trial Registration: NCT06285721, registered on 2024-02-19.

Aspiration pneumonia (AP) remains a clinical problem in long-term care facilities. However, evidence regarding modifiable care-related factors influencing swallowing remains inconsistent. We used a nationwide survey of residents in Japanese long-term care facilities to examine associations between oral frailty-related conditions, meal positioning strategies, and AP. This cross-sectional study analyzed nationwide survey data from residents at high risk of malnutrition in Japanese long-term care facilities. AP status was determined based on facility medical records. Oral frailty-related conditions and meal positioning factors were assessed using routine records. Logistic regression analyses evaluated associations with AP. Cumulative analysis examined associations between abnormal oral condition item counts and AP prevalence. Among 1204 residents, 8.1% (n = 97) reported AP. After full adjustment, inability to gargle (OR = 1.991; 95% CI: 1.139-3.479) and unclear speech (OR = 1.752; 95% CI: 1.085-2.829) remained significantly associated with AP. During meals, reclining angles of 0°-30° (OR = 4.024; 95% CI: 1.006-16.106) and 30°-60° (OR = 1.890; 95% CI: 1.074-3.327) were associated with AP. AP prevalence increased from 2.9% in residents with 0-1 abnormal oral frailty-related items to 13.1% in those with ≥ 4 items. AP was associated with cumulative oral frailty-related conditions and meal positioning among residents at high risk of malnutrition in long-term care facilities. Monitoring routine oral signs and optimizing seating angles may help reduce AP occurrence.

Depression and frailty are prevalent geriatric syndromes. Their co-occurrence may define a phenotype of heightened cardiovascular disease (CVD). In Latin America the joint association of these syndromes with CVD has not been previously characterised. To evaluate the association between the overlap of depression and frailty and the prevalence of CVD in older adults. A cross-sectional analysis was conducted using data from the 2015 SABE Colombia study. Adults aged ≥60 years with complete information on depression, frailty, and history of acute myocardial infarction or stroke defined as CVD were included. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using bivariate and multivariate log-binomial regression models. 18,973 participants were analysed (mean age 69.3 ± 7.1 years; 56% women). The prevalence of depression, frailty, and CVD was 57.3%, 3.5%, and 15.4%, respectively. In bivariate analyses, depression (PR 1.83, 95% CI 1.51-2.23), prefrailty (PR 1.61, 95% CI 1.50-1.73), and frailty (PR 2.91, 95% CI 2.57-3.28) were associated with CVD. In multivariate model, the overlap of depression and frailty demonstrated the strongest association with CVD (PR 4.86; 95% CI 3.37-7.01), exceeding that of depression with prefrailty and each condition individually. This association persisted after adjustment for traditional cardiovascular risk factors (PR 2.05, 95% CI 1.05-3.97). In older adults, the overlap of depression and frailty remained associated with a higher prevalence of CVD after adjustment for traditional cardiovascular risk factors. Although the association was attenuated after adjustment, the coexistence of both conditions remained associated with increased cardiovascular burden.

Limited research has assessed prospective associations of systemic inflammatory (GlycA) and immune (complement factor 3 [C3] and 4 [C4]) biomarkers with future cognition in midlife women, who potentially experience worsening inflammation around the menopause transition. We aim to assess the associations of midlife serum GlycA, C3, and C4 with future cognitive performance in women. Serum GlycA, C3, and C4 were repeatedly measured over 6.1 ± 3.9 years in 503 midlife women (1,234 observations) from the Study of Women's Health Across the Nation high-density lipoprotein ancillary study. Longitudinal measures of working memory, processing speed, and episodic memory, immediate and delayed recall, were administered 1.46 ± 0.95 years later. We applied joint models to examine the associations of baseline biomarkers and their changes since baseline with subsequent cognition. Higher levels of serum GlycA and complement factor 4 at baseline (50.17 ± 2.65 y) were significantly associated with worse working memory and better immediate recall, respectively, over the next decade. Higher baseline complement factor 4 and increases in C3 and C4 since baseline tended to associate with better future immediate and/or delayed recall. Higher baseline GlycA, rather than its changes since baseline, was associated with lower future working memory, whereas higher baseline complement factor 4 and increases in C3 and C4 since baseline appeared cognitively protective. Targeting inflammation amelioration and immunity improvement over the menopause transition may provide an open avenue to preserve future cognitive health.

Seasonal influenza causes substantial morbidity and mortality in older adults, yet vaccination coverage in this population remains low. This study evaluated the association between short message service (SMS)-based informational and reminder messages and influenza vaccination uptake among adults aged 65 y and older. In this single-center prospective study, an SMS reminder was sent at the beginning of the 2024-2025 influenza season to 1690 individuals aged&#x2009;&#x2265;65 y who had attended a family medicine outpatient clinic during the previous season. Demographic characteristics and prior-season influenza vaccination status were obtained from electronic medical records. At the end of the season, participants were contacted by telephone, and 338 individuals who completed follow-up were included in the final analysis. Influenza vaccination uptake increased from 16.9% in the 2023-2024 season to 31.4% in the 2024-2025 season, corresponding to an absolute increase of 14.5% points (p&#x2009;<&#x2009;.001). Among individuals vaccinated in the previous season, 52.6% were vaccinated again, while 27.0% of those unvaccinated in the previous season received the vaccine in the current season. In age-stratified analyses, the increase was significant in the young-old group (65-74 y) but not in the older age groups. In binary logistic regression analysis, prior-season influenza vaccination was the only factor significantly associated with current-season vaccination (OR,2.960; 95% CI,1.650-5.309; p&#x2009;<&#x2009;.001). Influenza vaccination uptake was significantly higher during the season in which SMS reminders were sent, suggesting that text messaging may support vaccination coverage among older adults, although additional age-tailored strategies may be needed for older subgroups.

In patients living with advanced dementia, the intensity of care during life-threatening infections remains controversial and marked by wide variation in practice. This international survey investigated physicians' and physicians-in-training's management choices for individuals with advanced dementia and the factors associated with those choices. Vignette-based survey. Twelve countries across five continents. We administered our vignette-based survey to medical students, residents and physicians. The survey elicited participants' views on whether antibiotics should be administered to an elderly patient with advanced dementia and very poor quality of life, presenting with bacterial pneumonia. We explored factors associated with treatment choices using univariable analysis and multiple logistic regression models. Of the 785 participants (age, mean (SD): 31.1 (11.5) years), one-third (31.2%) resided in the Region of the Americas, 21.9% in Europe, 16.2% in the Eastern Mediterranean region and 17.1% in China. In the univariable analysis, choice to treat was associated with younger age, country/WHO region (African region highest overall, European region lowest overall), stage of medical training (medical student most inclined to treat) and absence of medical assistance in dying (MAiD) legislation. Multivariable analyses provided evidence that country was the variable most strongly associated with the choice to treat with antibiotics (Cameroon, China, Saudi Arabia highest; Norway, Switzerland, Spain lowest), with the presence of MAiD legislation also strongly associated (OR 0.35, 95%&#x2009;CI 0.23 to 0.51). Age (OR 0.82, 95%&#x2009;CI 0.66 to 1.00)&#x2009;and religiosity level (OR 0.93, 95%&#x2009;CI 0.87 to 0.99) showed weaker associations with treatment decisions. Inclination to treat individuals with advanced dementia who develop pneumonia varies greatly between and within jurisdictions. Social factors (in particular country but also presence of MAiD legislation) proved the most prominent associations, with individual characteristics much less influential. These findings underscore the importance of contextual and cultural factors in value-sensitive clinical decisions. We registered the protocol at Open Science Framework (osf.io/6kfbt).

Cardiorespiratory fitness (CRF) is a powerful predictor of current and future health across all age groups. Recognising CRF's ability to screen health-related outcomes is essential for supporting its use in clinical practice. The aim was to evaluate the health-related diagnostic and prognostic accuracy of CRF using an overview of systematic reviews. Five bibliographic databases (MEDLINE, Embase, Scopus, CINAHL and SPORTDiscus) were searched from January 2002 to April 2025 to identify systematic reviews with meta-analyses that reported on the health-related diagnostic and prognostic accuracy of CRF. The results were presented using forest plots, with the certainty of evidence assessed by a modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Of the 10,796 papers identified, six systematic reviews with meta-analyses (n&#x2009;=&#x2009;31,171 observations) were included. Of these, five examined cardiovascular disease, events, or risk, and one examined mitochondrial disorders. CRF was measured objectively or estimated by exercise as maximum or peak oxygen consumption, ventilatory efficiency or fluctuation, or exercise performance or tolerance. All included reviews were graded as having low to critically low quality. CRF demonstrated high prognostic accuracy for predicting severe cardiovascular events in adults with heart failure, with moderate certainty (diagnostic odds ratio [dOR] 4.1-8.1; area under the curve of a summary receiver operating characteristic curve [SROC AUC] 0.73-0.77), and moderate-to-high diagnostic accuracy for detecting coronary artery disease in adults with type 2 diabetes or with suspected coronary artery disease with very low certainty (dOR 2.3-7.6; SROC AUC 0.66-0.79), mitochondrial disorders among adults with high certainty (dOR 18.1-26.6; SROC AUC 0.70-0.83), and cardiovascular disease risk among apparently healthy children and adolescents with low certainty (dOR 3.6-5.7; SROC AUC 0.64-0.71). CRF detects cardiovascular disease and mitochondrial disorders and predicts cardiovascular events among adults with chronic conditions and detects cardiovascular risk among apparently healthy children; however, the certainty of evidence ranged from very low to high certainty due to methodological limitations. Further research is needed to generate high-quality diagnostic evidence for CRF across diverse health outcomes and age groups in the general population. PROSPERO CRD42022370149.

Primary aldosteronism (PA) frequently coexists with obstructive sleep apnea (OSA), and this comorbidity is associated with increased cardiometabolic risk. Although both PA and OSA have been individually linked to gut microbiome alterations, it remains unclear which layer of gut microbiome-associated variation best reflects clinical heterogeneity in PA with coexisting OSA. In this prospective observational study, we performed shotgun metagenomic sequencing and untargeted fecal metabolomic profiling in 29 adults with clinically confirmed PA, who were stratified according to OSA severity (G1-G4) based on overnight polysomnography. Microbial gene richness, taxonomic composition, functional potential based on KEGG annotation, and antibiotic resistance gene profiles were analyzed using standardized bioinformatic workflows. Metabolomic variation was assessed using multivariate analysis, pathway enrichment, and additional exploratory analyses incorporating apnea-hypopnea index (AHI) as a continuous variable. Multiple-testing correction was applied to metabolite-level comparisons. Global gut microbial gene richness, alpha diversity, beta diversity, and broad functional profiles did not show strong group-level separation across OSA severity strata. Additional analyses using AHI as a continuous variable similarly showed no significant association between AHI and overall gene richness or alpha diversity indices. Nevertheless, selective genera showed exploratory associations with AHI, suggesting that localized taxonomic signals may occur despite relative stability of global community structure. Antibiotic resistance gene profiles showed marked inter-individual variability without clear group-level separation, although ARO richness showed an exploratory inverse association with AHI. In contrast, fecal metabolomic profiling revealed nominal phenotype-associated differences, including trehalose-related metabolites and FAHFA species that showed inverse exploratory associations with AHI. However, no individual metabolite remained significant after global Benjamini-Hochberg false discovery rate correction. In PA with coexisting OSA, gut microbiome-associated heterogeneity appears to be more readily reflected by selected taxonomic and metabolic signals than by global microbial diversity or broad functional potential. However, given the small sample size, limited control of clinical and lifestyle confounders, and lack of metabolite-level significance after global FDR correction, these findings should be interpreted as exploratory and hypothesis-generating. Larger controlled cohorts incorporating PA subtype, medication exposure, dietary assessment, and longitudinal validation are needed.

Avascular necrosis (AVN) is a progressive bone disorder characterized by impaired blood supply, osteocyte death, and structural collapse, most commonly affecting the femoral head. In recent years, growing evidence has suggested that gut microbiota may influence skeletal health through immune, metabolic, and vascular pathways. This scoping review aimed to systematically map current evidence on the relationship between gut microbiota and AVN and to identify key knowledge gaps. Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, a comprehensive search of PubMed, EMBASE, ScienceDirect, Web of Science Core Collection, ClinicalTrials.gov, and Cochrane CENTRAL was conducted. Thirteen eligible studies, including experimental, clinical, multi-omics, and Mendelian randomization analyses, were included. The available evidence indicates that AVN, particularly glucocorticoid- and alcohol-associated forms, is consistently associated with intestinal dysbiosis, reduced production of short-chain fatty acids, immune activation, vascular impairment, and altered bone remodeling. Animal and translational studies demonstrate partial reversal of pathological changes through microbiota-targeted interventions, while human studies reveal etiology-specific microbiota-metabolome signatures. Genetic analyses further support a potential causal contribution of selected microbial taxa and pathways. Overall, current data support the existence of a multidimensional gut-bone axis in AVN. However, most evidence remains indirect - derived from animal models, cross-sectional human studies, and genetic inference rather than from direct interventional testing in patients. Well-designed longitudinal and interventional investigations are needed to clarify causality and therapeutic potential.

Malnutrition is highly prevalent among hospitalized older adults and is associated with adverse clinical outcomes. However, the determinants of nutritional improvement and clinical implications of such improvement in oldest-old hospitalized patients remain insufficiently characterized. This study aimed to identify factors associated with nutritional improvement and to evaluate the relationship between this improvement and clinical outcomes among hospitalized patients aged &#x2265;80&#x202f;years who were at nutritional risk. This multicenter prospective cohort study included hospitalized patients aged &#x2265; 80&#x202f;years at nutritional risk (Nutritional Risk Screening 2002 score &#x2265; 3) from geriatric wards of tertiary hospitals in China. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) at admission and at 90-day follow-up. Nutritional improvement was defined as an improvement in MNA-SF category at 90&#x202f;days. Multivariable logistic regression analyses were performed to identify factors associated with nutritional improvement and to examine the association between nutritional improvement and adverse clinical outcomes, including mortality, readmission, falls, and infection. Among 675 patients included in the final analysis (mean age 88.5&#x202f;&#xb1;&#x202f;4.8&#x202f;years; 63.7% male), 251 (37.2%) achieved nutritional improvement at 90&#x202f;days. In multivariable analyses, a higher Charlson Comorbidity Index was associated with a lower likelihood of nutritional improvement (odds ratio [OR]&#x202f;=&#x202f;0.751, 95% confidence interval [CI]: 0.665-0.849, p&#x202f;<&#x202f;0.001). Achieving energy adequacy (OR&#x202f;=&#x202f;2.424, 95% CI: 1.511-3.887, p&#x202f;<&#x202f;0.001) and good adherence to nutritional interventions (OR&#x202f;=&#x202f;1.921, 95% CI: 1.303-2.834, p&#x202f;<&#x202f;0.001) were independently associated with nutritional improvement, whereas protein adequacy was not. Nutritional improvement was independently associated with reduced risks of readmission (OR&#x202f;=&#x202f;0.545, 95% CI: 0.351-0.847, p&#x202f;=&#x202f;0.007) and new infection (OR&#x202f;=&#x202f;0.388, 95% CI: 0.225-0.671, p&#x202f;<&#x202f;0.001) but was not significantly associated with mortality or falls. Among hospitalized oldest-old patients at nutritional risk, achieving adequate energy intake and maintaining adherence to nutritional interventions were independently associated with nutritional improvement. Nutritional improvement was associated with lower risks of readmission and infection. These findings highlight the potential clinical relevance of sustained nutritional monitoring and management in oldest-old hospitalized populations.

Nursing home residents (NHRs) remain among the most vulnerable to severe outcomes from SARS-CoV-2 infection. While mRNA-1273 (Spikevax, Moderna) and BNT162b2 (Comirnaty, Pfizer-BioNTech) vaccines are widely used in this population, comparative data on their immunogenicity, particularly after bivalent boosters, remain limited. We conducted a longitudinal immunologic evaluation of U.S. NHRs who received either the mRNA-1273 or BNT162b2 bivalent vaccine. Serum samples were collected 10-30 d post-vaccination. Anti-spike IgG levels were measured using a Luminex bead-based assay, and neutralizing titers were assessed via pseudovirus neutralization. Comparative analyses of the titer distributions were performed using two-sided Wilcoxon rank-sum tests. Both vaccine groups demonstrated strong humoral responses to the ancestral Wuhan strain and Omicron BA.4/5 subvariants. Spike-binding antibody levels and neutralization titers were comparable between the mRNA -1273 and BNT162b2 vaccine formulations. Conclusions: Both mRNA-1273 and BNT162b2 mRNA vaccines elicit similarly robust humoral immunity in NHRs, supporting their interchangeable use in booster strategies. Our findings underscore the importance of timely booster administration over exact product selection in protecting this high-risk, immunosenescent population.

3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy has emerged as a potential strategy to treat posttraumatic stress disorder (PTSD). We conducted a national serial cross-sectional study of U.S. Veterans with PTSD from January 1, 2018, to December 31, 2023, to quantify the prevalence of potential contraindications, risk factors, and drug-drug interactions relevant to MDMA-assisted therapy. Participants were required to have at least two diagnostic codes for PTSD within a calendar year. Each year, 303,451 to 326,315 participants received care for PTSD. The annual proportion of individuals with at least one contraindication for MDMA-assisted therapy ranged from 15.3% to 17.3%, and the annual proportion with at least one conditional or modifiable risk factor ranged from 55.2% to 58.2%. Each year, 85.7% to 87.5% of participants filled at least one prescription for another medication that potentially interacts with MDMA. Many individuals with PTSD have contraindications or conditional risk factors that may require additional evaluation prior to receiving MDMA-assisted therapy, but many may be eligible with careful management of modifiable conditions and potential drug-drug interactions. Our results have important implications for policymakers and clinicians as studies examining the safety and efficacy of MDMA-assisted therapy continue to evolve toward potential implementation.

This study examined the feasibility of patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) performing gaming tasks. Ten patients with MCI and nine patients with AD participated. Gaming and tabletop tasks were the two types of interventions designed for this study. Following a randomized crossover design, the two interventions were conducted at a rate of 1 hour per week for 4 weeks. The Genki! Ha&#x2022;tsu&#x2022;ra&#x2022;tsu Trepachi-table (TOYOMARU INDUSTRY CO., LTD., Aichi, Japan) device was used for the gaming intervention. Using this table-shaped gaming device with cognitive training components, one to four players can compete in various gaming challenges on a touchscreen mounted on the top of the table. For the tabletop task intervention, patients completed arithmetic and spot-the-difference exercises as cognitive training activities. A visual analog scale was used to quantify mood before and after each intervention session, and a reaction scale measuring the "autonomy" and "degree of participation" of patients was completed after each intervention. The gaming intervention significantly increased the visual analog scale score of the AD group (p=0.031). The MCI group had significantly higher autonomy reaction scale scores during the gaming intervention than the AD group (p=0.007). Activities using gaming technology may enhance the willingness and mood of senior citizens with diminished cognitive capabilities and could potentially support ongoing brain training.

To explore the implications of transitioning from traditional memory clinics to Brain Health Services (BHS) for older adults, and to advocate for a geriatric-informed, equitable, and function-oriented approach to brain health care. This perspective article draws on discussions within the EuGMS Brain Health and Dementia Specialist Interest Group and relevant literature to examine the implications of emerging Brain Health Services for older adults. The emergence of Brain Health Services represents a significant shift in cognitive healthcare, moving beyond traditional memory clinic models focussed primarily on dementia diagnosis and management towards prevention, risk reduction, and maintenance of cognitive function. Potential benefits include earlier engagement with cognitive care, multidomain lifestyle interventions, reduction of stigma surrounding dementia, and facilitation of access to emerging disease-modifying therapies. However, substantial challenges remain. Biomarker-driven approaches may overemphasise Alzheimer's disease-centric frameworks despite the high prevalence of mixed pathologies and complex comorbidity in older adults. Ethical concerns surrounding risk disclosure, inequitable access, and resource allocation are also considerable, particularly if services disproportionately benefit younger, healthier, or socioeconomically advantaged populations. Brain Health Services should be reframed through a gerontologically informed lens that prioritises function, independence, quality of life, and equitable access alongside prevention. Integration with comprehensive geriatric assessment and existing older persons' care pathways is essential. Future research should focus on pragmatic real-world evaluation, inclusive outcome measures, and personalised approaches that account for heterogeneity in ageing. Ultimately, the success of BHS will depend on their ability to support healthy ageing while remaining responsive to the lived realities and priorities of older adults.

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Older adults experience high rates of chronic disease that reduce quality of life and independence. In South Texas, these challenges are compounded by limited access to culturally aligned care and a high burden of chronic conditions. Addressing these disparities requires infrastructure that bridges research and practice to support the translation of evidence into real-world care. This manuscript describes the establishment of the Supporting Older Adults through Research Network (SOARNet), a population-specific practice-based research network (PBRN) and reports early lessons from its development and recruitment strategies. SOARNet employs a multi-level leadership structure and an Advisory Board to guide research priorities, review member-initiated proposals, and facilitate collaboration among clinical, research, and community stakeholders. Recruitment strategies included informational materials, clinic visits, and targeted email outreach. Since inception, SOARNet has enrolled 61 members representing healthcare clinicians (55.7%), researchers (18.0%), community members (32.8%), and organizations (8.2%), with targeted email outreach proving most effective (n = 56). SOARNet has supported a collaborative research study, facilitated member consultations, and contributed to dissemination activities. These findings demonstrate the value of population-specific PBRNs in advancing community-engaged translational research to improve care for older adults. Future priorities focus on expanding partnerships and strengthening culturally responsive, bidirectional research.

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Urinary tract infection (UTI) is a common complication after acute ischemic stroke (AIS) and is associated with delayed neurological rehabilitation. However, joint biomarkers that reflect stroke-related neuroendocrine-immune dysregulation remain insufficiently defined, and the association between UTI and longitudinal functional recovery has not been fully characterized. This retrospective cohort study included 122 patients with AIS. Baseline clinical parameters, free triiodothyronine to free thyroxine (FT3/FT4) ratios, and neutrophil-to-lymphocyte ratios (NLR) were collected. Multivariate logistic regression was used to identify independent risk factors for UTI. The incremental predictive value of combined biomarkers was evaluated using the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). A Generalized Estimating Equations (GEE) model was utilized to analyze the longitudinal repeated-measure modified Rankin Scale (mRS) scores at admission, 28 days, and 180 days. Among the 122 patients, 33 (27.0%) developed UTI. In the primary multivariable model, a high NLR (&#x2265; 3.78) and a low FT3/FT4 ratio (&#x2264; 0.31) were associated with increased UTI risk. The combined model significantly improved the predictive performance over the baseline clinical model (AUC increased from 0.735 to 0.842, DeLong test p = 0.016), with a continuous NRI of 0.635 (p < 0.001) and an IDI of 0.188 (p < 0.001). Furthermore, the GEE model identified a significant time &#xd7; group interaction (p = 0.014), indicating that UTI was associated with a slower longitudinal functional recovery trajectory. Post-stroke UTI was associated with poor 180-day functional outcome in the primary outcome model (adjusted OR = 3.28, 95% CI: 1.15-9.32, p = 0.026). The combination of baseline FT3/FT4 ratio and NLR provides incremental predictive value for post-ischemic stroke UTI. Furthermore, UTI was associated with a less favorable 6-month functional recovery trajectory, supporting early risk stratification and prevention-oriented management.

Sarcopenia, the age-related decline in muscle mass and strength is a growing challenge for older adults. This study investigates whether meeting the WHO physical activity guidelines (150-300 min/week of moderate or 75 min/week of vigorous exercise) with higher protein intake, based on the RDA, is associated with appendicular lean soft tissue index (ALSTI) and handgrip strength (HGS) in adults living in the United States aged 40-59 years. Data from the National Health and Nutrition Examination Survey 2007-2020 included 2540 adults aged &#x2265;40 years. Physical activity (moderate/vigorous) was self-reported, while higher protein intake was assessed via two 24-hour recalls (>0.8 g/kg/bodyweight). Linear regressions, adjusted for age, sex, BMI, race, education, comorbidities, and energy-adjusted protein intake were used to assess associations with ALSTI and HGS. In fully adjusted models, vigorous activity with higher protein intake (47.1 &#xb1; 5.6 years) was associated with ALSTI only after adjustments for age, sex, BMI, race, education (&#x3b2; = 0.37, SE 0.17, p = 0.047; mean baseline: 8.56 &#xb1; 1.67 kg/m2). No associations were found in the fully adjusted model for ALSTI (p = 0.31), and across all models for HGS (mean baseline: 43.6 &#xb1; 10.1 kg). Moderate activity with higher protein intake was not associated with HGS or ALSTI across adjusted models. Meeting vigorous or moderate-intensity activity guidelines with higher than the RDA protein intake was not associated with ALSTI or HGS in middle-aged US adults.